Title Page
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Document No.
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Environmental Stress Cracking: Site Audit
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Health Service
- Eastern Health
- Monash Health
- Barwon Health
- Austin Health
- Ballarat
- Alfred
- Eye & Ear
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Box Hill Hospital
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Monash Medical Centre
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University Hospital Geelong
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Austin Hospital
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Ballarat Base Hospital
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The Alfred
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The Royal Victorian Eye and Ear Hospital
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Conducted on
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Personnel
- Anthony Black
- Caroline Marshall
- Shevaun O'Loghlen
- Samantha Chen
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Location
Background Information
Site
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Has there been any recent major clinical redevelopments / refurbishments?
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Provide details
Cleaning / Disinfectant
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What is the principal cleaning / disinfectant used?
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Provide brand and product details
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How frequently are the high touch items cleaned?
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How frequently are the high touch items cleaned?
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Provide additional details, type, where the technology is used and frequency of use?
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How frequently are the high touch items cleaned?
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Has there been any Identified safety or equipment related issues associated with your cleaning solution?
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Do use any other cleaning disinfectant wipe / solutions ?
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Please list additional products and how are they used?
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Where is the wipe used?
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What is the frequency of use?
Maintenance
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Health Service Contact: Maintenance
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Title
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Contact Telephone
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Email:
Support Services
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Health Service: Support Services (Cleaning)
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Title:
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Contact Telephone:
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Email:
Medical Devices
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Health Services: Clinical Engineering (Biomedical)
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Title
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Contact Telephone:
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Email:
Clinical Services
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Health Services: Senior Clinical Representative
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Title
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Contact Telephone:
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Email:
Department (1)
Department:
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Have any medical devices or Infrastructure been identified as showing environmental stress cracking?
ESC may be:
• Brittle cracking with no indication of yielding or indentation.
• Fine hairline cracks.
• Multiple initiation points.
• Repeated cracking in the same item.
ESC
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What category of equipment?
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Provide select category of equipment?
- Patient Lifter
- Infusion Pump
- Monitor
- Foot pump
- Tympanic Thermometer
- Warmer System
- Sphygmomanometer
- Humidifier
- Bladder Scanner
- Ventilator
- Other
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Provide brand and model no:
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Add photos
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Extent of cracking per each individual item classified as:<br> 0 – No cracking<br>1 – Minor (1 or 2 small cracks)<br>2 – Major (multiple cracking)<br>3 – Severe (extensive cracking and resulting material loss and damage
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- Electrical Outlets
- Ice Machine
- Communication Handset
- Washer
- Hand Towel
- Bed side cart
- Other
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Provide details
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Provide brand and model no:
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Add Photos
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Extent of cracking per each individual item classified as:<br> 0 – No cracking<br>1 – Minor (1 or 2 small cracks)<br>2 – Major (multiple cracking)<br>3 – Severe (extensive cracking and resulting material loss and damage
Department (2)
Department:
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Have any medical devices or Infrastructure been identified as showing environmental stress cracking?
ESC may be:
• Brittle cracking with no indication of yielding or indentation.
• Fine hairline cracks.
• Multiple initiation points.
• Repeated cracking in the same item.
ESC
-
What category of equipment?
-
Provide select category of equipment?
- Patient Lifter
- Infusion Pump
- Monitor
- Foot pump
- Tympanic Thermometer
- Warmer System
- Sphygmomanometer
- Humidifier
- Bladder Scanner
- Ventilator
- Other
-
Provide brand and model no:
-
Add photos
-
Extent of cracking per each individual item classified as:<br> 0 – No cracking<br>1 – Minor (1 or 2 small cracks)<br>2 – Major (multiple cracking)<br>3 – Severe (extensive cracking and resulting material loss and damage
-
- Electrical Outlets
- Ice Machine
- Communication Handset
- Washer
- Hand Towel
- Bed side cart
- Other
-
Provide details
-
Provide brand and model no:
-
Add Photos
-
Extent of cracking per each individual item classified as:<br> 0 – No cracking<br>1 – Minor (1 or 2 small cracks)<br>2 – Major (multiple cracking)<br>3 – Severe (extensive cracking and resulting material loss and damage
Department (3)
Department:
-
Have any medical devices or Infrastructure been identified as showing environmental stress cracking?
ESC may be:
• Brittle cracking with no indication of yielding or indentation.
• Fine hairline cracks.
• Multiple initiation points.
• Repeated cracking in the same item.
ESC
-
What category of equipment?
-
Provide select category of equipment?
- Patient Lifter
- Infusion Pump
- Monitor
- Foot pump
- Tympanic Thermometer
- Warmer System
- Sphygmomanometer
- Humidifier
- Bladder Scanner
- Ventilator
- Other
-
Provide brand and model no:
-
Add photos
-
Extent of cracking per each individual item classified as:<br> 0 – No cracking<br>1 – Minor (1 or 2 small cracks)<br>2 – Major (multiple cracking)<br>3 – Severe (extensive cracking and resulting material loss and damage
-
- Electrical Outlets
- Ice Machine
- Communication Handset
- Washer
- Hand Towel
- Bed side cart
- Other
-
Provide details
-
Provide brand and model no:
-
Add Photos
-
Extent of cracking per each individual item classified as:<br> 0 – No cracking<br>1 – Minor (1 or 2 small cracks)<br>2 – Major (multiple cracking)<br>3 – Severe (extensive cracking and resulting material loss and damage
